Enrollment Form - Foreign Language College Mombasa

Personal Information

Trimester

Year

Full Names

Gender

Male

Female

ID Number

Place of Birth

Date of Birth

Residence

Profession

P.O. Box

Email

Telephone

Guardian (if applicable)

Admission Details

Course Enrolled For

Intake

Admission Number (Official Use)

Language & Level Selection

I would like to be admitted in (cross the box):

Medical Details

Are you challenged in any of the following areas? (Tick the right one)

Hearing

Mobility

Sight

Learning

Other

None

Statistical Information

This information will be used for statistical purpose ONLY.

How did you learn about Foreign Language College Mombasa?

Internet

TV

Radio Billboard

Highschool

Other

Friend

Payment Information

Amount Paid (KES)

Payment Date

Payment Method

Payment Instructions

Please make payments to our M-PESA PayBill number: 4082661

Course Fees

Account Number: ID No or passport no/admission number/intake

Example: "A1, 30416666_April"

Examination Fees

Account Number: Exam & Date, candidate's surname, initial of first name

Example: "SD1,27_jan_XXXX, X."

IMPORTANT: School fee once paid CAN NOT BE REFUNDED. Please review all information before submitting.

Declaration

Signature

Date

I hereby declare that the information provided in this form is true and correct to the best of my knowledge. I have read and agree to the Conditions of Enrollment.